Vascular Injuries Caused by Orthopaedic Screws

Safar, Hussein A.; Emad, Ali; Nakhi, Hozaifah; Asfar, Sami

doi:10.1159/000078321

Cited by 8 publications

(5 citation statements)

References 11 publications

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Section: Resultsmentioning

confidence: 99%

“…Two of these were systematic reviews that investigated proximal femoral fractures 6 and total hip arthroplasty 12 , with the majority being retrospective studies and 1 questionnaire sent to vascular surgeons 22 . In addition, there were multiple case reports of arterial, nervous, and ureteric injury due to screw placement and drill bit use [24][25][26][27][28][29] 15 , electrical conductivity devices 61,62 , electromyography 63 , stimulus-evoked potential 64 , bioimpedance drills 65 , and acoustic emission-signal analysis 66 .…”

Section: Prevalence Of Iatrogenic Injury Using Power Toolsmentioning

confidence: 99%

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Power-Tool Use in Orthopaedic Surgery

et al. 2021

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Background:Power tools are an integral part of orthopaedic surgery but have the capacity to cause iatrogenic injury. With this systematic review, we aimed to investigate the prevalence of iatrogenic injury due to the use of power tools in orthopaedic surgery and to discuss the current methods that can be used to reduce injury.Methods:We performed a systematic review of English-language studies related to power tools and iatrogenic injuries using a keyword search in MEDLINE, Embase, PubMed, and Scopus databases. Exclusion criteria included injuries related to cast-saw use, temperature-induced damage, and complications not clearly related to power-tool use.Results:A total of 3,694 abstracts were retrieved, and 88 studies were included in the final analysis. Few studies and individual case reports looked directly at the prevalence of injury due to power tools. These included 2 studies looking at the frequency of vascular injury during femoral fracture fixation (0.49% and 0.2%), 2 studies investigating the frequency of vertebral artery injury during spinal surgery (0.5% and 0.08%), and 4 studies investigating vascular injury during total joint arthroplasty (1 study involving 138 vascular injuries in 124 patients, 2 studies noting 0.13% and 0.1% incidence, and 1 questionnaire sent electronically to surgeons). There are multiple methods for preventing damage during power-tool use. These include the use of robotics and simulation, specific drill settings, and real-time feedback techniques such as spectroscopy and electromyography.Conclusions:Power tools have the potential to cause iatrogenic injury to surrounding structures during orthopaedic surgery. Fortunately, the published literature suggests that the frequency of iatrogenic injury using orthopaedic power tools is low. There are multiple technologies available to reduce damage using power tools. In high-risk operations, the use of advanced technologies to reduce the chance of iatrogenic injury should be considered.Level of Evidence:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Section: Resultsmentioning

confidence: 99%

Section: Prevalence Of Iatrogenic Injury Using Power Toolsmentioning

confidence: 99%

Power-Tool Use in Orthopaedic Surgery

et al. 2021

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“…Penetrating and blunt traumas appear to be the most common etiological factors (Table 1), although numerous reports of iatrogenic PPAs, following either orthopedic interventions or vascular and endovascular surgical procedures, and even acupuncture, appear more often in the literature. [9][10][11][12][13][14] Bony exostoses or osteochondromas of the distal femur and proximal tibia have been reported to lead to the formation of PPAs, 15,16 due to proximity lacerations of the arterial wall.…”

Section: Discussionmentioning

confidence: 99%

Traumatic Pseudoaneurysm of the Popliteal Artery After Blunt Trauma: Case Report and a Review of the Literature

Megalopoulos

Siminas

Trelopoulos

2007

Vasc Endovascular Surg

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Pseudoaneurysms of the popliteal artery following trauma are rare lesions. We present 3 cases of pseudoaneurysms of the popliteal artery (4, 20, and 45 years old respectively) with a delayed presentation, following blunt trauma, presenting over a 3-year period, and a short review of the relevant literature. A delayed pattern of presentation, over 2 years after blunt popliteal trauma, was observed in all patients. They presented with a painful pulsatile mass in the popliteal fossa, and their peripheral pulses were normal. Orthopedic and rheumatologic evaluation findings were negative. Diagnostic evaluation included triplex, arteriography, and computed tomography angiography. A posterior popliteal approach was used, and after aneurysmal excision, reversed great saphenous vein and lesser saphenous vein (1 patient) grafts were used. After 2 to 4 years of follow-up, all grafts remain patent and the patients have fully functional limbs. A literature search revealed 70 cases of pseudoaneurysms of the popliteal artery reported in civilian settings. These lesions should be repaired shortly because their complications (rupture, thromboembolic episodes) carry a high risk for limb dysfunction and amputation. Penetrating or blunt trauma is the main causative factor (62.5%), but iatrogenic trauma accounts for an increasing number of reports (37.5%). Strict follow-up of popliteal trauma is essential. A high level of suspicion and awareness can lead to early diagnosis and treatment of pseudoaneurysms of the popliteal artery and prevent the serious complications associated with these lesions.

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“…A false aneurysm of the axillary artery has been reported after intramedullary nailing of a fracture of the proximal humerus locked by a long proximal screw. 11 The propensity for metal placed in the shoulder to migrate is well recognised. [7][8][9] Wires have been known to enter the thoracic cavity and to be located in the heart.…”

Section: Discussionmentioning

confidence: 99%